Vijayvergiya Rajesh, Kapoor Divya, Aggarwal Ajay, Sangwan Sonal, Suri Vanita, Dhawan Veena
Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Experimental Medicine & Biotechnology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India.
Mol Cell Biochem. 2017 Aug;432(1-2):67-78. doi: 10.1007/s11010-017-2998-9. Epub 2017 Mar 23.
Premenopausal women are known to have less heart disease than their menopausal counterparts and men. However, there is a rising prevalence of coronary artery disease (CAD) in premenopausal females, which necessitates determination of risk factors that negate the effects of hormonal protection. There are few studies describing the prevalence of traditional and emerging risk factors in premenopausal women with CAD. Thus, our objective was to explore the prevalence of traditional and emerging risk factors and features of coronary lesions in premenopausal women with CAD in an Indian population. Forty premenopausal female patients with angiographically proven CAD and undergoing treatment with conventional therapies and 40 age-matched premenopausal females without any evidence of CAD were enrolled. Premenopausal females with CAD most commonly had the single-vessel CAD and the left anterior descending artery was most commonly involved. The prevalence of hypertension, diabetes, obesity, metabolic syndrome, family history of CAD and 10-year risk score was higher in premenopausal females with CAD than controls. Even after treatment with conventional therapies, premenopausal women with CAD had dyslipidemia and significantly elevated levels of emerging risk factors such as ApoB, ApoB/ApoA1 ratio, hsCRP, lipoprotein (a), uric acid, T4, fibrinogen, and total leukocyte count as compared to controls (p < 0.05). Further, they had significantly lower levels of HDL-C, and Apolipoprotein A1 and T3 which are protective markers for vascular risk. Multivariate regression analysis demonstrated that low levels of Apo A1 and high levels of fibrinogen, hsCRP and TG drive the vascular risk, and therefore these factors should be considered as candidates for better diagnosis, early detection, and intervention of CAD in premenopausal women.
已知绝经前女性患心脏病的几率低于绝经后女性和男性。然而，绝经前女性冠状动脉疾病（CAD）的患病率正在上升，这就需要确定那些抵消激素保护作用的危险因素。很少有研究描述绝经前CAD女性中传统和新出现危险因素的患病率。因此，我们的目的是探讨印度人群中绝经前CAD女性的传统和新出现危险因素的患病率以及冠状动脉病变特征。纳入了40名经血管造影证实患有CAD且正在接受传统治疗的绝经前女性患者，以及40名年龄匹配、无任何CAD证据的绝经前女性。患有CAD的绝经前女性最常见的是单支血管CAD，最常受累的是左前降支动脉。患有CAD的绝经前女性中，高血压、糖尿病、肥胖、代谢综合征、CAD家族史和10年风险评分的患病率高于对照组。即使经过传统治疗，患有CAD的绝经前女性与对照组相比仍存在血脂异常，且新出现的危险因素如载脂蛋白B（ApoB）、ApoB/ApoA1比值、高敏C反应蛋白（hsCRP）、脂蛋白（a）、尿酸、甲状腺素（T4）、纤维蛋白原和总白细胞计数显著升高（p < 0.05）。此外，她们的高密度脂蛋白胆固醇（HDL-C）、载脂蛋白A1和三碘甲状腺原氨酸（T3）水平显著较低，而这些是血管风险的保护性标志物。多变量回归分析表明，低水平的Apo A1和高水平的纤维蛋白原、hsCRP及甘油三酯（TG）会增加血管风险，因此这些因素应被视为绝经前女性CAD更好诊断、早期检测和干预的候选因素。
